Ethics in Nursing and healthcare

Introduction

Ethics are declarations of what is right or wrong usually presented as a system of value behaviors and beliefs with the purpose of governing conduct to ensure protection of an individual’s rights (Catalano, 2003). A code of ethics is a written list of a profession’s values and standards of conduct, which provides a framework for decision making for the profession. There are some important ethical principles which include autonomy, justice, fidelity, beneficence nonmaleficence, veracity, standard of best interest, and obligations.

Autonomy:

Catalano (2003) said, “Autonomy is the right of self-determination, independence, and freedom” (p. 118). The individual patient has the right to make health-care decisions for himself or herself, even if the health-care provider does not agree with those decisions.

Justice:

Justice is defined as “the obligation to be fair to all people"(Catalano, 2003, p.118). The individuals have the right to be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief. It is important to protect human right to have equal access to healthcare.

Reflection for practice improvement

Reflective practice has been developed in nursing as a method of accessing and building the experiential knowledge. Bulman & Schutz (2008) stated that reflection is a reviewing experience from practice which is described, analyzed, evaluated and then used to inform and change future practice. According to Dewey (1933), reflection involves opening up one’s practice for others to examine, and consequently requires courage and open-mindness as well as a willingness to take on board and act on criticism (as cited in Bulman & Schutz, 2008). Therefore, reflection involves more than intellectual thinking since it is intermingled with practitioners’ feelings and emotion and acknowledges an interrelationship with action.

Thinking is fundamental to human life and inquiry, and reflection is thinking through rational and intrusive process which can lead to implement change and improve clinical practice. Effective reflection on practice leads to more conscious, deliberative and intentional interventions. Reflection on beliefs, values and norms offer the opportunity to examine, articulate and generate local philosophies and theories of care, as well as assessing the contribution of the individual to health care delivery (Freshwater, Taylor, & Sherwood, 2008).

With true reality, reflection provides us a vehicle through which we can communicate and justify the importance practical knowledge. After all, reflective practice can only be developed by becoming immersed in actually doing and practicing.

Hand hygiene compliance

World Health Organization (2009) highlighted that the magnitude of HCAI burden worldwide which should be emphasized as an important issue and it is overly underestimated. According to Allegranz and Pittet (2009), the hospital-wide studies and long-term follow up reports showed that there is a temporal association between improved hand hygiene practice and reduced infection rates. In their review paper, therefore, they spotlighted that hand hygiene is the leading measure to prevent transmission of HCAI and antimicrobial resistant.They also found out that optimal level of hand hygiene compliance among health care providers is low in most of the setting. It is to promote hand hygiene through multimodal interventions which appeared to be the most suitable strategy to behavioural change. Allegranz and Pittet (2009) also noted that introduction of alcohol-based hand rubs and continuous educational programmes are key factors to challenge barriers to hand hygiene compliance.

Larson, Quiros and Lin (2007) conducted a study to evaluate compliance with CDC hand hygiene guidelines and compare the rates of HCAI before and after guidelines recommendations. They designed pre-and post-guidelines implementation site visits and surveys in 40 US hospitals, using direct observation of hand hygiene compliance and guideline implementation score. Their study results showed that hand hygiene compliance rate remained low and there is no impact of guidelines implementation on HAI rates.

Factors affecting Quality Improvement in Healthcare

The Federal government plays a vital role in supporting the delivery of safe, high quality care, including paying for care, monitoring quality, addressing disparities, providing technical assistance, supporting research, and directly providing care to the communities (Department of Health and Human Services, U.S., 2011).

Public and private supports to healthcare providers’ desire to deliver higher quality care are critically important. It is important to dedicate resources to QI activities. The executive team must be supportive; they must create financial and human resources, and allow sufficient time for the project team to work. Collaborative efforts at the local level are also a vital resource for measuring, monitoring, and improving quality of care (Department of Health and Human Services, U.S., 2011).

Community leaders and members themselves play a crucial role in healthcare quality improvement. Community-based programs, working out local values, forming coalitions around specific problems will enhance local health care services.

Qualification of the health care providers is another factor affecting healthcare quality improvement. Therefore, health care professionals should be encouraged to maximize their training and skills through life-long learning that includes the application of QI principles. At the same time, boards of medicine, nursing, and other providers enhance the quality of care that patients receive by requiring that practitioners continually demonstrate skills and knowledge critical to their field (Department of Health and Human Services, U.S., 2011).

Technical component has strong impact to facilitate QI implementation. A study conducted on QI implementation among Korean hospitals by Lee, Choi, Kang, Cho & Chae (2002) showed that the relevant scientific analytical skills and the establishment of a quality information system with valid data are key success factors for CQI implementation. They justified this result with another study finding that inadequate information system and technical skills are barriers against implementation of CQI in healthcare areas.

Organizational culture, the underlying beliefs, values, norms and behaviours of the organization, strongly influence the productivity and efficacy of that organization. Lee, Choi, Kang, Cho & Chae (2002) stated that employee empowerment and autonomy are key cultural factors to be emphasized when an organization pursues CQI. They explained about four culture types which are group, developmental, rational and hierarchical in nature.

Group culture emphasizes the development of human resources, affiliations, employee empowerment, teamwork and consensus building. Developmental culture pursues changes and growth, and regards innovative thoughts and prospective strategies as important assets. Rational culture is highly performance oriented and emphasizes on planning, productivity and efficacy. In hierarchical culture, bureaurocracy and stability are the underlying forces that move the organization, and compliance with organizational mandates, enforced roles, rules, and regulations are emphasized.

Based on the conceptual disciplines of CQI, Lee, Choi, Kang, Cho & Chae (2002) hypothesized that group and developmental culture would be more likely to achieve a higher degree of CQI, and CQI implementation would be positively correlated with the extent to which organization empowered their employees and allowed them decision-making autonomy. Systematic literature review by Minkman, Ahaus & Huijsman (2007) showed that large hospital experienced lower clinical efficiency due to more bureaucratic and hierarchical cultures.

Reference:

Department of Health and Human Services, U.S. (March 2011). Report to Congress: National Strategy for Quality Improvement in Healthcare. Retrieved 26 April, from http://www.healthcare.gov/law/resources/reports/quality03212011a.html

Lee, S. H., Choi, K.,  Kang, H.,  Cho, W., & Chae, Y. M. (2002). Assessing the factors influencing continuous quality improvement implementation: Experience in Korea hospitals. International Journal for Quality in Health Care, 14(5), 383-391. Retrieved http://intqhc.oxfordjournals.org

Minkman, M., Ahaus, K., Huijsman, R. (2007). Performance improvement based on integrated quality management models: What evidence do we have? A systematic literature review. International Journal for Quality in Health Care, 19(2), 90-104. Retrieved http://intqhc.oxfordjournals.org